MEDICARE: DR. JORGE LUIS MENENDEZ MD,FACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	G8281	TX

General Provider Information

NPI Number	:	1225031289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE LUIS MENENDEZ MD,FACS

Provider Business Mailing Address
First Line	:	PO BOX 91199
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-9097
Country	:	US
Telephone Number	:	210-829-7411
Fax Number	:	210-829-7899

Provider Business Practice Location Address
First Line	:	7744 BROADWAY ST
Second Line	:	STE 210
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3262
Country	:	US
Telephone Number	:	210-829-7411
Fax Number	:	210-829-7899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/15/2007

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